In the US in 1997 the National Institute of Health’s working group on priority setting recommended using public health needs as a criterion for research . Similar recommendations have later been made in other countries , which has motivated research to assess the correlation between research funding and measures of disease burden. Some of these studies, which have been conducted in the US, the UK, and Australia, reveal high correlations between research funding and measures of disease burden [1, 3–7]. However, other studies dispute this [2, 6, 8, 9], and cancer, in particular, appears to attract more funds relative to disease burden compared with other diseases [2, 5, 7, 9]. Some of the literature in this field has examined different cancers with the general finding that breast cancer attracts more funding relative to disease burden than other types of cancer [1, 3, 6, 8].
While the association between research funding and burden of disease has been investigated in several countries, little attention has been paid to national research investments and global disease burden. Such considerations are important given recent calls for new strategies for incorporating a global perspective into investments in health research [10–12]. Health threats, as a result of globalization, are becoming increasingly transnational and social determinants of health at the national level are influenced by global markets, migrations, and communication. Efficient management of global health resources are thus needed. Furthermore, it can be argued that Norway, as a rich country, has a special responsibility to conduct research that reflects the health needs of developing countries .
It has been suggested that health need is a key criterion for deciding the allocation of resources for both treatment and research [14, 15]. However, health need alone is not a sufficient criterion to determine research priority, i.e., twice the health need does not justify twice the investment in research. Such a decision must also depend on the opportunity for progress in the area. Without this consideration, less overall scientific progress in the field of health research would be accomplished, which would lead to less of a reduction in the burden of disease than what could have been achieved otherwise. In addition, there are a range of other criteria, such as feasibility of the intervention, equity, and cost-effectiveness, which must be included in a comprehensive analysis to ensure that important considerations are not overlooked. Hence, this is not a prioritization analysis, but rather a contribution to the debate on global research funding.
The aim of the following analysis was to assess the correlation between Norwegian research investments and both the Norwegian and global burden of disease. This was possible as both the Research Council of Norway and the Regional Health Authorities have adopted the International Health Research Classification System (HRCS) to classify part of their efforts in health research . As a measure of Norwegian and global morbidity/mortality, we used data from the International Global Burden of Disease (GBD) 2010 project [17, 18].
Data and methods
Research in health and medical sciences performed by public institutions in Norway is financed through different channels, including the Ministry of Health and Care Services, the Ministry of Education and Research, the Research Council of Norway (RCN), the Regional Health Authorities (RHA), charities, international sources, and private companies . Charities, international sources, and private companies, however, were only responsible for 12% of the total investments in public sector health research in 2011; thus, 88% was publicly funded . In comparison with other high income nations, Norway has a low involvement of the private sector in health research .
We used portfolio data from the RCN  and RHAs in 2012 to calculate research activity and investments. Resource allocation was calculated based on the financial investments in each of the projects in 2012. The RCN has used the HRCS since 2011 and we included, from the RCN, investments related to the target area “Better health and health care”. This amounted to NOK 783 million (EUR 104 million), which was approximately 85% of the RCN’s overall investments in the health field in 2012.
The RHAs have, since 2009, used HRCS to classify a part of their projects. Hence, we could include approximately 29% (NOK 810 million, EUR 107 million) of the RHA’s total expenditures (NOK 2.8 billion, EUR 371 million) on research in 2012 . We included the part of their portfolios which was funded through liaison committees between the RHAs and the universities. Most of these funds are earmarked research allocations from the Ministry of Health and Care Services to the specialist health care services. However, some are also basic funding from block grants to a broadly defined type of activity, including patient treatment, education, and research. The part that is not classified by HRCS (NOK 2 billion, EUR 264 million), and thus not included in our analysis, consists mostly of block grants to broadly defined activities. It is not known if the HRCS profiles we observe are representative of the overall research effort in the RHAs .
In total, we include an amount of roughly NOK 1.6 billion (EUR 211 million) in research funding. The total research investments in the public sector in the field of medicine and health have not been estimated for 2012. However, in 2011 this was NOK 6.2 billion (EUR 822 million) .
Measures of burden of disease
Several health-based burden measures have been proposed (e.g., disability-adjusted life years (DALYs), quality-adjusted life years, years of life lost (YLLs), and mortality), which have different characteristics. In the following study, we apply YLLs and DALYs, for Norway and globally, from the GBD 2010 project [17, 18]. GBD 2010 is an international project based at the Institute for Health Metrics and Evaluation at the University of Washington. The aim of the project is to provide a comparative overview of population health and mortality as well as associated risk factors. The results are stratified by age, gender, region, and country. YLL measures loss of life due to premature mortality and is calculated by subtracting the age at death from the life expectancy for a person at that age. The use of DALYs was initiated by the World Bank and WHO as an overall measure of disease burden . DALYs equal the sum of YLLs and years lived with disability. Hence, this measure incorporates loss of life due to nonfatal health conditions with one DALY equal to the loss of one year of healthy life.
The disease groups used in the HRCS and GBD categories are not directly comparable. Hence, we created our own disease groups, which are displayed (Additional file 1). An important weakness is that we could not match the HRCS categories “Other” and “Generic Health Relevance” with the disease-specific categories of the GBD. These accounted for 30% of the RCN’s investments and 13% of the RHAs’ investments, thus constituting 22% of the total investments in the analysis.
To illustrate the association between research investments and disease burden, we used scatter plots supplemented with linear trends. We also calculated correlation coefficients (Pearson’s) for each association.